“Treating Through” Decision and Follow-up in Antibiotic Therapy-Associated Exanthemas

Trautmann, Axel; Benoit, Sandrine; Goebeler, Matthias; Stoevesandt, Johanna

doi:10.1016/j.jaip.2017.03.032

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…For benign exanthems, there is some evidence to suggest that, in the case of an acute exanthem and if the drug (an antibiotic) is still indicated, it can be continued with at least a temporary clinical tolerance (35). For patients with a history of a benign exanthem who have stopped the drug but require it in the future, there is relative consensus amongst groups for the use of graded reintroduction or a more prolonged desensitization over several hours or days, although the mechanism by which these procedures work is not known.…”

Section: Controversies and Differences Across Regionsmentioning

confidence: 99%

Controversies in drug allergy: Testing for delayed reactions

Phillips

Bigliardi

Bircher

et al. 2019

Journal of Allergy and Clinical Immunology

169

170

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Controversies exist with regards to in vivo approaches to delayed immunologically mediated adverse drug reactions (ADR) such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruption. In particular, widespread differences exist between regions and practice on the availability and use of intradermal testing (IDT) and patch testing, the standard drug concentrations used, the use of additional drugs in IDT and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T-cell mediated reactions that have shed light on immunopathogenesis and provided a mechanism of pre-prescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine SJS/TEN in Southeast Asians. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches such as skin testing and patch testing combined with ex vivo and in vitro laboratory approaches.

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Section: Controversies and Differences Across Regionsmentioning

confidence: 99%

Controversies in drug allergy: Testing for delayed reactions

Phillips

Bigliardi

Bircher

et al. 2019

Journal of Allergy and Clinical Immunology

169

170

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show abstract

“…In near future, we need to obtain data about DHRs during the disease from ongoing clinical trials and DHR registries. Additionally as time passes, we will observe if SARS‐CoV‐2 can aggravate T cell–mediated reactions as some viruses do, 219 and if the hyperinflammation observed during the course of the disease may influence DHRs.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

Gelincik

Brockow

Çelik

et al. 2020

Allergy

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Coronavirus disease 2019 (COVID‐19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID‐19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off‐label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings together all the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off‐label drugs and highlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactions in the course of the disease.

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“…Sub-febrile temperature or a slight increase of liver enzymes are occasionally observed during episodes of an exanthematous rash, but may also be caused by the infectious disease treated with the β-lactam antibiotic. Aminopenicillin-induced measles-like exanthem does not belong to the spectrum of severe drug reactions, and the fear that Stevens-Johnson syndrome or toxic epidermal necrolysis will develop, if the causative aminopenicillin is continued or re-administered is not justified [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Predominant patterns of β-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins

Schrüfer

Brockow

Stoevesandt

et al. 2020

Allergy Asthma Clin Immunol

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Background Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific β-lactams are scarce and inconsistent. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected β-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results β-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing β-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all β-lactam allergic patients tolerated at least one, usually several alternative substances out of the β-lactam group. Conclusions We identified two patterns of β-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type β-lactam hypersensitivity.

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“Treating Through” Decision and Follow-up in Antibiotic Therapy-Associated Exanthemas

Cited by 25 publications

References 24 publications

Controversies in drug allergy: Testing for delayed reactions

Controversies in drug allergy: Testing for delayed reactions

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

Predominant patterns of β-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins

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